Skip to main content

Institutional-Level Tracking to Combat Mistreatment of Medical Students, Residents, and Fellows

  • Chapter
  • First Online:
Integrity of Scientific Research

Abstract

Mistreatment is prevalent in academic medicine resulting in personal and professional harm to individuals. Medical trainees that experience mistreatment have higher rates of burnout, suicidal ideation, and attrition. Additionally, mistreatment has deleterious effects on clinical team function and patient care. It is essential that academic institutions track mistreatment, as well as take appropriate prevention and mitigation steps. The following chapter outlines the prevalence of mistreatment among medical trainees, types of mistreatment, and current tracking tools. A framework for determining the optimal intervention and entity best positioned to intervene based on the type of mistreatment is presented. The process of mapping measures of mistreatment to both type and level of intervention is necessary to create a more equitable training environment.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Cook DJ, Liutkus JF, Risdon CL, Griffith LE, Guyatt GH, Walter SD (1996) Residents’ experiences of abuse, discrimination and sexual harassment during residency training. CMAJ 154(11):1657–1665

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Yau BN, Chen AS, Montgomery KB, Dubuque N, McDowelle DM (2021) An internal perspective: the psychological impact of mistreatment. Acad Psychiatry 45(3):308–314

    Article  PubMed  Google Scholar 

  3. Babaria P, Abedin S, Berg D, Nunez-Smith M (2012) “I’m too used to it”: a longitudinal qualitative study of third year female medical students’ experiences of gendered encounters in medical education. Soc Sci Med 74(7):1013–1020

    Article  PubMed  Google Scholar 

  4. Richardson DA, Becker M, Frank RR, Sokol RJ (1997) Assessing medical students’ perceptions of mistreatment in their second and third years. Acad Med 72(8):728–730

    Article  CAS  PubMed  Google Scholar 

  5. Silver HK, Glicken AD (1990) Medical student abuse: incidence, severity, and significance. JAMA 263(4):527–532

    Article  CAS  PubMed  Google Scholar 

  6. Hill KA, Samuels EA, Gross CP, Desai MM, Sitkin Zelin N, Latimore D et al (2020) Assessment of the prevalence of medical student mistreatment by sex, race/ethnicity, and sexual orientation. JAMA Intern Med 180(5):653–665

    Article  PubMed  PubMed Central  Google Scholar 

  7. Fnais N, Soobiah C, Chen MH, Lillie E, Perrier L, Tashkhandi M et al (2014) Harassment and discrimination in medical training. Acad Med 89(5):817–827

    Article  PubMed  Google Scholar 

  8. Li SF, Grant K, Bhoj T, Lent G, Garrick JF, Greenwald P et al (2010) Resident experience of abuse and harassment in emergency medicine: ten years later. J Emerg Med 38(2):248–252

    Article  PubMed  Google Scholar 

  9. Hu Y-Y, Ellis RJ, Hewitt DB, Yang AD, Cheung EO, Moskowitz JT et al (2019) Discrimination, abuse, harassment, and burnout in surgical residency training. N Engl J Med 381(18):1741–1752

    Article  PubMed  PubMed Central  Google Scholar 

  10. Lu DW, Lall MD, Mitzman J, Heron S, Pierce A, Hartman ND et al (2020) #MeToo in EM: a multicenter survey of academic emergency medicine faculty on their experiences with gender discrimination and sexual harassment. West J Emerg Med 21(2):252–260

    Article  PubMed  PubMed Central  Google Scholar 

  11. de Bourmont SS, Burra A, Nouri SS, El-Farra N, Mohottige D, Sloan C et al (2020) Resident physician experiences with and responses to biased patients. JAMA Netw Open 3(11):e2021769

    Article  PubMed  PubMed Central  Google Scholar 

  12. National Academies of Sciences, Engineering, and Medicine (2018) Sexual harassment of women: climate, culture, and consequences in academic sciences, engineering, and medicine. The National Academies Press, Washington, DC

    Google Scholar 

  13. Jagsi R, Griffith KA, Jones R, Perumalswami CR, Ubel P, Stewart A (2016) Sexual harassment and discrimination experiences of academic medical faculty. JAMA 315:2120–2121

    Article  PubMed  PubMed Central  Google Scholar 

  14. McDade WA (2019) Accreditation C for GME. Integrating a sustainable diverse and inclusive GME workforce. In: AAMC learn serve lead, Phoenix, AZ

    Google Scholar 

  15. Cook AF, Arora VM, Rasinski KA, Curlin FA, Yoon JD (2014) The prevalence of medical student mistreatment and its association with burnout. Acad Med 89(5):749–754

    Article  PubMed  PubMed Central  Google Scholar 

  16. Frank E, Brogan D, Schiffman M (1998) Prevalence and correlates of harassment among US women physicians. Arch Intern Med 158(4):352–358

    Article  CAS  PubMed  Google Scholar 

  17. Thomas NK (2004) Resident burnout. JAMA 292:2880–2889

    Article  CAS  PubMed  Google Scholar 

  18. Association of American Medical Colleges (AAMC) (2009) Striving toward excellence: faculty diversity in medical education. Washington, DC. yumpu.com/en/document/read/22797053/. Accessed 4 May 2021

  19. Cooper-Patrick L, Gallo JJ, Gonzales JJ, Vu HT, Powe NR, Nelson C et al (1999) Race, gender, and partnership in the patient-physician relationship. JAMA 282(6):583–589

    Article  CAS  PubMed  Google Scholar 

  20. Saha S, Komaromy M, Koepsell TD, Bindman AB (1999) Patient-physician racial concordance and the perceived quality and use of health care. Arch Intern Med 159(9):997–1004

    Article  CAS  PubMed  Google Scholar 

  21. Alsan M, Garrick O, Graziani GC (2019) Does diversity matter for health? experimental evidence from Oakland. Am Econ Rev 109:4071–4111

    Article  Google Scholar 

  22. Smedley BD, Stith AY, Nelson AR (2003) Unequal treatment: confronting racial and ethnic disparities in health care. The National Academies Press, Washington DC. pubmed.ncbi.nlm.nih.gov/25032386/. Accessed 4 May 2021

    Google Scholar 

  23. Pierce CM, Carew JV, Pierce-Gonzalez D, Wills D (1977) An experiment in racism. Educ Urban Soc 10(1):61–87

    Article  Google Scholar 

  24. Sue DW, Capodilupo CM, Torino GC, Bucceri JM, Holder AMB, Nadal KL et al (2007) Racial microaggressions in everyday life: implications for clinical practice. Am Psychol 62(4):271–286

    Article  PubMed  Google Scholar 

  25. Sklar DP (2019) Recognizing and eliminating shame culture in health professions education. Acad Med 94:1061–1063

    Article  PubMed  Google Scholar 

  26. Aryee S, Sun LY, Chen ZX, Debrah YA (2007) Antecedents and outcomes of abusive supervision: test of a trickle-down model. J Appl Psychol 92(1):191–201

    Article  PubMed  Google Scholar 

  27. Pololi LH, Brennan RT, Civian JT, Shea S, Brennan-Wydra E, Evans AT (2020) Us, too. Sexual harassment within academic medicine in the United States. Am J Med 133(2):245–248

    Article  PubMed  Google Scholar 

  28. Wear D, Keck-McNulty C (2004) Attitudes of female nurses and female residents toward each other: a qualitative study in one U.S. Teaching Hospital. Acad Med 79(4):291–301

    Article  PubMed  Google Scholar 

  29. Gjerberg E, Kjølsrød L (2001) The doctor-nurse relationship: how easy is it to be a female doctor co-operating with a female nurse? Soc Sci Med 52(2):189–202

    Article  CAS  PubMed  Google Scholar 

  30. Mustapha T, Ho Y, Andrews JS, Cullen MJ (2019) See no evil, hear no evil, stop no evil: institutional-level tracking to combat mistreatment of residents and fellows. J Grad Med Educ 11(5):601–605

    Article  PubMed  PubMed Central  Google Scholar 

  31. McKinley SK, Wang LJ, Gartland RM, Westfal ML, Costantino CL, Schwartz D et al (2019) “Yes, I’m the Doctor”: one department’s approach to assessing and addressing gender-based discrimination in the modern medical training era. Acad Med 94:1691–1698

    Article  PubMed  Google Scholar 

  32. Sue DW (2010) Microaggressions in everyday life: race, gender, and sexual orientation. John Wiley & Sons, Hoboken, NJ

    Google Scholar 

  33. Silver JK, Rowe M, Sinha MS, Molinares DM, Spector ND, Mukherjee D (2018) Micro-ineq Med 10:1106–1114

    Google Scholar 

  34. Ashkanasy NM, Jackson CRA (2000) Organizational culture and climate. In: Handbook of organizational culture and climate. Sage Publications, Inc, Thousand Oaks, CA, pp 398–415

    Google Scholar 

  35. Sukhera J, Watling CJ, Gonzalez CM (2020) Implicit bias in health professions. Acad Med 95(5):717–723

    Article  PubMed  Google Scholar 

  36. Banyard VL, Moynihan MM, Cares AC, Warner R (2014) How do we know if it works? Measuring outcomes in bystander-focused abuse prevention on campuses. Psychol Violence 4(1):101–115

    Article  Google Scholar 

  37. Newkirk P, Diversity, Inc (2019) The failed promise of a billion-dollar business. Bold Type Books, New York, NY

    Google Scholar 

  38. Giuliano L, Levine DI, Leonard J (2011) Racial bias in the manager-employee relationship: an analysis of quits, dismissals, and promotions at a large retail firm. J Hum Resour 46(1):26–52

    Google Scholar 

  39. Steinke P, Fitch P Minimizing bias when assessing student work. files.eric.ed.gov/fulltext/EJ1168692.pdf. Accessed 4 May 2021

  40. Acosta D, Karp DR (2018) Restorative justice as the rx for mistreatment in academic medicine: applications to consider for learners, faculty, and staff. Acad Med 93(3):354–356

    Article  PubMed  Google Scholar 

  41. Karp DRSMGT (2018) Restorative justice in universities: case studies of what works with restorative responses to student misconduct. In: The Routledge international handbook of restorative justice. Routledge, New York, NY. Chapter 17

    Google Scholar 

  42. Llewellyn J, MacIsaac J, MacKay M. Report from the restorative justice process at the Dalhousie University Faculty of Dentistry. whistler.bibliocommons.com/v2/record/S49C126606603. Accessed 4 May 2021

  43. Zelek B, Phillips SP (2003) Gender and power: nurses and doctors in Canada. equityhealthj.com/content/2/1/1. Accessed 4 May 2021

  44. Fried JM, Vermillion M, Parker NH, Uijtdehaage S (2012) Eradicating medical student mistreatment. Acad Med 87(9):1191–1198

    Article  PubMed  PubMed Central  Google Scholar 

  45. Carbado DW, Gulati M (2000) Working identity. Cornell Law Rev 85(5):1270–1278

    Google Scholar 

  46. Offermann LR, Basford TE, Graebner R, Degraaf SB, Jaffer S (2013) Slights, snubs, and slurs: leader equity and microaggressions. Equal Divers Incl 32(4):374–393

    Article  Google Scholar 

  47. AAMC webinars and online courses: restorative justice for academic medicine (RJAM): Using RJ to respond to mistreatment and bias (tier II). aamc.elevate.commpartners.com/products/restorative-justice-for-academic-medicine-rjam-using-rj-to-respond-to-mistreatment-and-bias-tier-ii-november-21-2019. Accessed 4 May 2021

  48. Person SD, Jordan CG, Allison JJ, Fink Ogawa LM, Castillo-Page L, Conrad S et al (2015) Measuring diversity and inclusion in academic medicine: the diversity engagement survey. Acad Med 90(12):1675–1683

    Article  PubMed  PubMed Central  Google Scholar 

  49. Coker AL, Bush HM, Cook-Craig PG, DeGue SA, Clear ER, Brancato CJ et al (2017) RCT testing bystander effectiveness to reduce violence. Am J Prev Med 52(5):566–578

    Article  PubMed  PubMed Central  Google Scholar 

  50. Justice beyond bars: exploring the restorative justice alternative for victims of rape and sexual assault. thefreelibrary.com/Justice+beyond+bars%3A+exploring+the+restorative+justice+alternative...-a0414824835. Accessed 4 May 2021

  51. Estrada AX, Olson KJ, Harbke CR, Berggren AW (2011) Evaluating a brief scale measuring psychological climate for sexual harassment. Mil Psychol 23(4):410–432

    Google Scholar 

  52. Major A (2014) To bully and be bullied: harassment and mistreatment in medical education. Virtual Mentor 16:155–160

    Article  PubMed  Google Scholar 

  53. Hunt D, Barzansky B, Migdal M (2009) When bad things happen in the learning environment. Virtual Mentor 11:106–110

    PubMed  Google Scholar 

  54. Priesemuth M, Schminke M, Ambrose ML, Folger R (2014) Abusive supervision climate: A multiple-mediation model of its impact on group outcomes. Acad Manag J 57(5):1513–1534

    Article  Google Scholar 

  55. Minikel-Lacocque J (2013) Racism, college, and the power of words. Am Educ Res J 50(3):432–465

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jessica Hane .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Hane, J., Mustapha, T. (2022). Institutional-Level Tracking to Combat Mistreatment of Medical Students, Residents, and Fellows. In: Faintuch, J., Faintuch, S. (eds) Integrity of Scientific Research. Springer, Cham. https://doi.org/10.1007/978-3-030-99680-2_19

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-99680-2_19

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-99679-6

  • Online ISBN: 978-3-030-99680-2

  • eBook Packages: Social SciencesSocial Sciences (R0)

Publish with us

Policies and ethics